Investigating the relationship between socioeconomic status and domestic violence against women in Isfahan, Iran in 2021: A cross‐sectional study

Abstract Background and Aims Domestic violence can include controlling or coercive behaviors and acts, as well as physical, sexual, psychological, and financial elements. Given the significance of domestic violence against women and its complications, this study looked into the relationship between socioeconomic status and domestic violence against women in Isfahan in 2019. Methods In 2021, a cross‐sectional study of 427 married women referred to comprehensive health centers in Isfahan, Iran, was carried out. The available sampling method was chosen. To collect data, a domestic violence questionnaire and a socioeconomic status index were used. The data were analyzed using SPSS and Latent GOLD software. Results The average age of the women in this study was 33.21, 37% worked, and 63 were housewives. Based on Latent class analysis method, women were classified into two groups of high or low socioeconomic status class. The findings revealed a significant relationship between socioeconomic status and different types of violence against women, including light physical violence, emotional violence, verbal violence, and sexual violence (p < 0.05). Conclusion The findings revealed that there is a significant relationship between socioeconomic status and domestic violence against women in Isfahan, with women from lower socioeconomic backgrounds being more vulnerable to violence. Given the prevalence of violence against women in the family and its consequences, policy makers should look for the causes of this type of violence as well as solutions to reduce this health and social problem. Factors such as the expansion of counseling and treatment centers in health care facilities, as well as education and life skills training, are particularly important in reducing this phenomenon in society.


| INTRODUCTION
Domestic violence is a social issue that has occupied the minds of social researchers for a long time and is not only affected by different aspects of human life, but will also affect them. 1 Domestic violence, which can occur in relationships or between partners, is frequently used as a term for intimate partner violence, which is committed by one of the people in an intimate relationship against the other.
Violence against women refers to acts of aggression performed predominantly or only by men or boys against women or girls. Such violence, which is frequently categorized as a type of hate crime. 2 and is frequently directed toward women or girls solely for being female, can take many different forms.
Domestic violence is a phenomenon in which a woman is subjected to violence and violation of her rights by the other sex because of her gender. If this type of behavior occurs within the framework of the family and between the husband and wife, it is considered to be domestic violence. 3 Violence against women is a public health and social issue with numerous physical and psychological consequences. According to the findings of various studies, all types of pains, digestive problems, bleeding, abortion, and damage to body organs such as eardrum rupture, blindness, and broken limbs are common among victims of violence. 4,5 This problem also causes depression, anxiety, posttraumatic stress disorder, irritable bowel syndrome, headache, suicidal thoughts, panic attacks, and other symptoms. 6,7 In comparison to other regions like America (30%) and Europe (25%), South East Asia (38%), and Africa (37%) were shown to have greater regional prevalence rates of intimate partner violence. 8 According to the Iranian Statistics Center, the total number of cases of physical examination of spouse abuse claimants in 2019 indicates that during this year, 80,187 cases of physical examination were conducted by the forensic doctor, with the majority of claimants being women. There were 77,000 cases of physical spousal abuse investigated in these examinations, with 2900 men claiming physical spousal abuse. 9 In fact, women claiming physical spousal abuse accounted for 96% of all forensic medical examinations related to physical spousal abuse claimants in 2013, while men claiming physical wife's abuse accounted for 4%. 10,11 Although domestic violence against women exists in all societies and socioeconomic classes, it appears that women in lower economic and social situations face more violence, and factors such as low literacy, low income, poverty, a lack of resources, and problems caused by having children are significant in people who engage in or are victims of violence. 12 The nature of this phenomenon varies by country; for example, in Ghana, violence against women can have religious, social, cultural, sexual, physical, emotional, psychological, or economic aspects. 13 In reviewing the research done in Iran on this subject, various factors have been found to be effective in relation to domestic violence and in reducing or increasing it, such as increasing age, 14 higher education for women, 15 and female employment. 16 In there has been an increase in violence in some cases, a decrease in violence in others, and no connection with violence in some cases. 17 As can be seen from the studies, the majority of these studies have investigated the various dimensions of violence and the consequences associated with it, while an aspect related to the socioeconomic index has not been investigated. 18 The socioeconomic status of the household is regarded as one of the most important variables influencing domestic violence. 19 This variable influences the mental and social health of community members throughout their lives, and having a suitable socioeconomic status through mechanisms Biological, psychological, and social factors can influence a person's decision to adopt healthy behaviors, form appropriate social and family relationships, and experience lower rates of social harm, including domestic violence against women. 20,21 The prevalence of domestic violence and specifically violence against women in the provinces of Iran is different and even in small geographical areas. Since the metropolis of Isfahan has a distinct cultural, social, and economic context, it includes various ethnic groups and social groups, including families with different socioeconomic statuses and immigrants, it was deemed necessary to investigate this phenomenon. As far as we know, no study on the relationship between the index of socioeconomic status and domestic violence has been conducted in Iran or in Isfahan. As a result, the purpose of this study was to investigate the relationship between socioeconomic status and the experience of various types of violence among women in Isfahan. vaccination in a number of centers, the researcher was only allowed to visit the centers recommended by the experts. Based on this, we used available sampling in this study at the center selection stage. But after that, women were included in the study through random classification sampling. In the end, 15 centers (3 centers from each geographical region of Isfahan) were randomly selected.
We included all Isfahan women seeking care at comprehensive health centers in our sample. In fact, people go to comprehensive health centers to receive normal healthcare services even though they may not necessarily have a specific disease and have health records.

| Inclusion and exclusion criteria
Women who were married, at least 1 year had passed since their marriage, were between the ages of 18 and 49, and were not going through a divorce were all required to meet the inclusion criteria.
Women who were divorced or whose spouses had passed away at the time of the survey were excluded.

| Measurement
To collect information, a checklist related to demographic variables, questionnaire of violence against women and socioeconomic status index were used.
Checklist related to demographic variables includes information such as woman's age, husband's age, and woman's age at the time of marriage, woman's employment status, husband's employment status, woman's education level, and husband's education level.

| Violence against women questionnaire
The questionnaire of violence against women was designed by Alipour et al. 22 and includes 19 questions that cover five dimensions of severe physical violence, light physical violence, emotional violence, verbal violence, and sexual violence. Each of the components of violence against women questionnaire was scored as never (1), very little (2), little (3), moderate (4), high (5), and very high (6).
The score of each dimension was obtained from the sum of its items, and the total score of the questionnaire was obtained by summing the five dimensions.
Validity and reliability of the questionnaire have been investigated by Alipour et al. exploratory factor analysis was used to determine validity and Cronbach's α coefficient was used to determine reliability. The value of Cronbach's α coefficient for this questionnaire was 0.86. 22

| Construction of socioeconomic status
Latent class analysis method 23 was used to construct the socioeconomic status index of the household. In this study, property indicators and social variables were used to construct SES as follows: Owning a television, owning a car, owning a dishwasher, owning a computer/laptop, owning a microwave, owning a smart cell phone, owning a home, education of a woman, education of a husband.
The variables of wife's and husband's education were measured at rank level (primary education, middle school, high school, and university education including diploma and higher). Other variables were measured at nominal level (have/does not have).
Based on this, four models were estimated and finally, the model with two hidden classes was selected based on the relatively low values of the Bayesian Information Criterion (BIC) and Cluster error, as well as the corresponding graphs. The studied women were classified into two groups of high/low socioeconomic class.   (Table 1).

| Data analysis
In the part of analytical findings, the index of the socioeconomic status of the household was created using the latent class analysis method, based on four models which were estimated, finally the model with two hidden classes were selected according to the relatively low values of the BIC and Cluster error and related graphs. Therefore, the studied women were classified into two groups of high socioeconomic class and low socioeconomic class (Figure 1).
In the next step, the t-test of two independent samples was used to compare the relationship between the types of violence against women based of SES status of Household. The results showed that there is a relationship between socioeconomic status and light physical violence, emotional violence, sexual violence, and verbal violence (p < 0.05), but no relationship was observed between socioeconomic status and severe physical violence ( Table 2). According to the T-test, the first hypothesis, "a significant relationship between the socioeconomic status of the household and severe physical violence against women," was not statistically T A B L E 1 Socio-demographic characteristic of the study population.  Our finding was consistent with Ince-Yenilmez' study. 25  The association between lower socioeconomic status and higher prevalence of domestic violence against women can be explained by lack of access to resources and increased acceptance of violence.
Consistent with our study, Semahegn and Mengistie 33 and Alhabib et al. 34 concluded that a history of abuse reinforces the normative nature of violence, thus making men more likely to perpetrate and women more likely to accept violence.
However, our findings were contrary to the findings of Pambè et al. 35 and Vyas et al. 36 In these two studies, factors such as women's participation in decision-making, community-level influences, the existence of value beliefs, financial independence, and high human capital in women were able to make the relationship between economic-social status and violence against women not to be significant.
The third hypothesis, "a significant relationship between household socioeconomic status and emotional violence against women," was confirmed by the T-test. It should be noted that the scope of violence encompasses a wide range of human behavior. In Iran, T A B L E 2 Comparison of the means of types if violence against women based on high/low socio-economic status (SES). Physical violence has decreased as society's culture has changed, but emotional and psychological violence has increased. 37 Educational, legal, and supportive strategies such as empowering families, among others, have been reported to improve skills in dealing with spousal violence. Our findings are consistent with studies of Afkhamzadeh et al. 38 and Asadi et al. 14 Beside, in two studies conducted in Malaysia, Othman et al. 39 and Haron et al. 40 reported that emotional abuse was as the most common form of violence against women in Malaysia.
In a national household survey study of 36 countries in developing countries, WILSON. 41  In the resource theory, VanderEnde et al. 47 also state that men in households with low SES rely more heavily on violence as a means of controlling their partners in domestic decision-making than do they have other resources (such as wealth or educational qualifications).
Overall, the results of our study are consistent with previous WHO 48 report showing higher prevalence of domestic violence in low-to middle-income countries compared to wealthier countries.
The economic status of household may have influenced women's empowerment, increased literacy, women's economic dependence, and more gender-equal norms in society.

| Limitations
In this study, we've faced some limitations. The main limitation of our work was women's reluctance to fill out the questionnaire due to the sensitivity of the questions about sexual violence. According to this case, the researcher assured the women that the questions would be kept confidential and that the research results would only be used for policy and legislation to improve women's psycho-social health. writing-review and editing.

ACKNOWLEDGMENTS
We thank the participants for taking part in the study and making it a success. The study was funded by Isfahan University of Medical Sciences, Isfahan, Iran with research code No. 399123.

CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author.
However, they are not publicly available due to privacy and ethical restrictions.

ETHICS STATEMENT
The study received the required ethics approval from the Isfahan sign a written informed consent in which they have been assured that their identities and responses will be anonymous and that participants' data will be kept confidential as possible. All authors have read and approved the final version of the manuscript. The corresponding author has full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

TRANSPARENCY STATEMENT
The lead author Mehdi Nosratabadi affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.